Provider Demographics
NPI:1609058395
Name:PHARR, ANGELA H (PA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:H
Last Name:PHARR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:CHRISTINE
Other - Last Name:HANNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 51008
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71135-1008
Mailing Address - Country:US
Mailing Address - Phone:318-798-9400
Mailing Address - Fax:318-798-3894
Practice Address - Street 1:2727 HEARNE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3931
Practice Address - Country:US
Practice Address - Phone:318-798-9400
Practice Address - Fax:318-798-3894
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200148363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1115380Medicaid
LA1115380Medicaid